About the job
Job Title: HEDIS Nurse (Remote – Florida Residents Only)
Job Type: W2 ongoing contract (HEDIS Season)
Schedule: Monday – Friday, 8:00 AM – 5:00 PM ET (100% Remote)
- Flexibility Required: There may be days when work extends beyond 8 hours or includes weekends to meet project needs.
Job Description
The HEDIS Nurse will collaborate with the HEDIS team to collect, review, and analyze member records by contacting healthcare providers and documenting results in a specified database. If necessary, the review process may include visiting provider offices or hospital institutions. This role requires a high level of telephonic interaction, follow-up on requested medical records, and maintaining detailed documentation of research and provider communications.
Key Responsibilities:
- Collect and review medical records for HEDIS measures through telephonic and occasional on-site provider interactions.
- Conduct thorough data abstraction and entry into designated databases with high accuracy.
- Maintain detailed and organized documentation of research efforts and provider contacts.
- Meet productivity standards in a high-volume, fast-paced environment while adhering to quality requirements.
- Contribute to the success of team goals by sharing strategies and supporting department responsibilities.
- Ensure compliance with HEDIS Technical Specification requirements.
Required Qualifications:
- Licensure: Must be a licensed nurse (RN, LPN, or LVN) and a graduate of an accredited school of nursing.
- Skills and Experience:
- Proficiency in analyzing ICD-10 codes and CPT-4 codes based on HEDIS Technical Specifications.
- Strong attention to detail and tenacity in finding claims-specific data within specific timeframes.
- Effective written, verbal, and interpersonal communication skills.
- Strong computer skills, including Microsoft Office proficiency and basic Excel knowledge.
- Ability to type 30-40 WPM and familiarity with Adobe Pro preferred.
- Critical thinking and problem-solving skills for conducting methodical and thoughtful research.
- Ability to read and interpret physician handwriting accurately.
- Prior HEDIS experience is a plus.